[The maternal-fetal immune relationship in pregnancy]

The mother establishes with the fetus a special interaction in pregnancy allowing his normal survival in spite of the different HLA antigens. The main factors contributing to these favourable conditions for the fetus are an efficient local immunosuppression and the formation of a protective barrier between the mother and the fetus. A number of substances are responsible for the local immunosuppression and include cytokines, prostaglandins, hormones as well as various other proteins of pregnancy. In addition, cytokines produced by TH2 lymphocytes seem to be predominant with respect to those of TH1 cells. An effective protection is provided by the trophoblast layer, which not only forms a physical barrier between the mother and the fetus but evades the immune attack of the mother by expressing inhibitory molecules of the complement system and by down regulating the expression of HLA antigens. Data obtained from murine models and clinical observation in pathological pregnancies suggest that an abnormal immune response of the mother against the feto-placental unit may be responsible for the occurrence of recurrent spontaneous abortions. This is proved by the ability of the partner's lymphocytes administered to females in the mouse model prior to mating to reduce the incidence of abortions. Unfortunately, similar treatment in women with recurrent abortion does not appear to be very effective.